The prevalence of various chronic diseases was compared in 517 individuals with alopecia areata, and 2,969 of their first degree relatives. As previous reports have suggested an increased incidence of diabetes in relatives of patients with alopecia areata, special attention was given to the prevalence of Type 1 and Type 2 diabetes in the patients and in their relatives. Several immunologic diseases were increased in alopecia probands and relatives. Thyroid disease, vitiligo, Addison disease, and pernicious anemia were more prevalent in probands and in their relatives than in the general population. Specifically, a high rate of thyroid disease was found in probands (14.7%) and in their first degree relatives (4.2%). Only one proband had Type 1 diabetes, yet there were 14 sibs with Type 1 diabetes. Thus, Type 1 diabetes was significantly more prevalent in the sibs (1.2%) than in either the probands with alopecia (0.2%), or the general population (0.12-0.25%) (P < 0.05)). In contrast, Type 2 diabetes was not more common in probands or in sibs than in the general population. These data suggest that alopecia areata protects against Type 1 diabetes in predisposed individuals. The high rate of thyroid disease suggests that screening probands and first degree relatives for thyroid disease should be considered.

BACKGROUND:The relationship between psychiatric disorders and alopecia areata has not been well studied. Although previous reports have been unable to correlate psychiatric illness with hair loss, a recent study determined that 74% of patients with alopecia areata (AA) under evaluation had one or more lifetime psychiatric diagnoses.METHODS:Two hundred and ninety-four community-based patients with alopecia areata responded to a detailed questionnaire distributed by Help Alopecia International Research, Inc. The prevalence of psychiatric disorders was determined using diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-IIIR).RESULTS:Major depression, generalized anxiety disorder, social phobia, and paranoid disorder were all present in patients with alopecia areata at rates significantly higher than in the general population.CONCLUSIONS:Alopecia areata patients are at a higher risk of developing psychiatric comorbidity during their clinical course.

Cutis marmorata telangiectatica congenita associated with congenital glaucomaTo the Editor: Picascia and Esterly described the occurrence of glaucoma in 2 of 22 patients with cutis marmorata telangiectatica congenita and commented on one previously reported infant who was similarly affected (J AM ACAD DERMATOL 1989;20:1098-104).We have seen two additional infants with both conditions, I which suggests that this may be a relatively frequent association.In all fivecases the glaucoma occurred when an eye was overlaid by a vascular abnormality.The vascular abnormality was a nevus f1ammeus in four cases and cutis marmorata telangiectatica in the fifth.However, study of the published photographs demonstrates an unusual degree of mottling or reticulation in these facial lesions, thereby making difficult the clinical distinction between nevus f1ammeus and the usual vascular lesions of cutis marrnorata telangiectatica.The association between glaucoma and an overlying nevus f1ammeus (at least in the setting of the Sturge-Weber syndrome) is well known, suggesting, as Picascia and Esterly noted, that an overlap exists between the two types of skin lesions.However, because our patients had an abnormal filtration angle rather than the increased episcleral venous pressure usually seen with nevus flammeus, perhaps the pathophysiology in the two settings is different.In any case one can conclude that there is a need to investigate underlying glaucoma in any patient who presents with cutaneous vascular abnormalities in the distribution of the first branch of the trigeminal nerve.

An open, multicenter study was conducted to evaluate the efficacy and adverse effects of ketoconazole in patients with cutaneous fungal infections seen in typical dermatology practices. One hundred twelve American investigators entered 954 patients into this trial. Responses based on clinical and mycologic assessments were available on 672 patients. Mycologic evaluations were conducted using pre- and post-therapy wet mounts in potassium hydroxide. Eighty percent of these patients were mycologically clear and clinically rated as either excellent (cured) or marked improvement. Adverse effects were mild to moderate in severity and only rarely caused therapy to be interrupted. Gastrointestinal effects were the most frequently reported complaints.